Ready or Not: It's ICD-10 Time

Are you ready for some chaos?

Time's up. After years of handwringing, delays, excuses, and predictions of doom: the ICD-10 era begins tomorrow.

And surprisingly, there are those who are now saying that sometimes even 70,000 diagnosis codes aren't enough.

That's what seems to be the case for one ENT practice visited by Jamesville, N.Y.-based practice management consultant Rosemarie Nelson, MS, as providers there struggled to get used to the upcoming ICD-10 codes.

"They can't always find the ICD-10 code for something they had an ICD-9 code for," said Nelson, who writes a "Practice Pointers" column for MedPage Today. A doctor there was looking for a code for a particular procedure "and the only thing that came close was cleft palate, and he said, 'That's crazy.'" Another code came out as encephalitis, "and that was nowhere near what the patient had. That's kind of the biggest complaint, and it shocked me."

Practices nationwide are scrambling to figure out the right codes as Thursday approaches; that's the day providers must stop using the current ICD-9 diagnosis codes, and switch to the newer, more specific ICD-10 codes. The move is mandated by the Centers for Medicare and Medicaid Services (CMS) for the Medicare and Medicaid programs, and is also being implemented by private insurers. But with 69,823 diagnosis codes to choose from now -- as opposed to ICD-9's 14,025 codes -- having too few codes would initially seem to be the least of anyone's problems.

Practices are doing whatever they can to get ready for the transition. For example, Carolinas HealthCare System, a network of 900 healthcare facilities throughout North and South Carolina, has been gearing up for the conversion since 2011, but "as we lead up to the Oct. 1 go-live, our project team is going through final go-live readiness preparations and final vendor and payer assessments," Craig D. Richardville, MBA, the system's senior vice president and chief information officer, said in an email.

"Communication will be key for our impacted teammates as we move forward with the transition with a large focus on promoting ICD-10 education tools and resources and our command center preparations. We have contingency plans in place to bring in additional staff if needed and have scheduled daily executive leadership touch points after the go-live."

Texas Children's Hospital in Houston is taking a similar approach. "To prepare for the Oct. 1 deadline, we are currently training the last of our team members on the 'big picture' of clinical documentation improvement and how ICD-10 helps that," said Austin Frazier Jr., the hospital's director of information management, in an email. "We are also double-checking that our partners on the payer and clearinghouse side are as prepared as possible for the new codes we will be sending."

Indeed, the readiness of vendors, as well as insurers, is a common concern. "We feel [our institution] is prepared, but a successful conversion is also dependent upon the readiness and execution of our clearinghouse and payer partners," Dan Riley, associate vice chancellor for clinical finances at the University of Arkansas for Medical Sciences in Little Rock, said in an email.

The university has had a long-standing project team dedicated to the implementation of ICD-10, Riley said. "All physicians went through online or in-person training, while the coding and support staff completed formalized coding classes." The university also participated in payer testing to clearinghouses and payers from April to the end of August.

Staten Island University Hospital in Staten Island, N.Y., has designated "champions" to assist staff members with any questions or problems they may have during the transition to ICD-10, according to a hospital spokeswoman.

In addition to training for physicians and hospital employees, "Data integration across all systems has been validated and approved for both ICD-9 and -10 coding," she said in an email. "Information systems will have a Help Desk to support any application or billing issues and will avidly monitor system performance to identify and resolve all ICD-10 issues that may arise through year-end processing."

Of course, all of these preparations take time away from other work. "The primary focus during this last week is reducing the number of unbilled accounts to allow for concentration on new cases that will require ICD-10 code assignment," said Gabriela Grygus, MBA, senior director of health information management at the NYU Langone Medical Center in New York City, in an email.

"Coders continue to review coding updates and guidelines while dual-coding several cases per day," Grygus said. The medical center is also using the Internet to provide clinicians with specialty-specific documentation tips.

Columbia University Medical Center in New York City has set up its own ICD-10 "command center," according to the medical center's website. "The command center ... has established a hotline and email account for rapid resolution of ICD-10 launch-related issues. Both phone and email will be live and monitored by Sept. 30," the website says. "The center is intended to create a feedback loop that will track trends, resolve escalated issues, and update departments on a daily or as-needed basis, depending on the issue."

The transition to ICD-10 "is not going to be as financially disruptive in the beginning as we originally thought," largely because CMS is giving providers a little leeway in getting the codes exactly correct, as long as they are generally in the correct "family" of codes, Nelson said. "For that reason, I think we got some breathing room."

Practices who haven't yet prepared themselves for ICD-10 "might get lucky and get a clearinghouse that they're going to buy extra services from, or decide they are going to ship [claims] out to a billing service and pay for coding service, but they would have to give the billing service access to their electronic health records so they can read them and code [accordingly]," she added.

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